Medicare Initial Preventative Physical Examination
Medicare has expanded coverage to include one initial preventive physical examination (IPPE), including a screening electrocardiogram (EKG) during the first six months of Part B enrollment for beneficiaries enrolled on or after Jan. 1.
Services Included in IPPE:
• Review of an individual's medical and social history, with attention to modifiable risk factors for disease detection including family history
• Review of an individual's risk factors for depression, using an appropriate screening instrument for persons without a current diagnosis of depression
• Review of the individual's functional ability and level of safety based on the use of appropriate standardized screening questions or a screening using available standardized screening tests
• An examination to include measurement of the individual's height, weight, blood pressure, a visual acuity screen, and other factors as deemed appropriate based on the individual's medical and social history
• Performance and interpretation of an EKG
• Education, counseling, and referral as deemed appropriate based on the results of the review and evaluation services described above and
• Education, counseling, and referral, including a brief written plan (e.g., a checklist or alternative) provided to the individual for other preventive services if needed.
Resulting new codes include:
• G0344 (IPPE; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment)
• G0366 (Electrocardiogram, routine ECG with 12 leads; performed as a component of the initial preventive examination with interpretation and report)
• G0367 (tracing only, without interpretation and report; performed as a component of the initial preventive examination) and
• G0368 (interpretation and report only, performed as a component of the initial preventive examination).
If the primary physician or qualified NPP does not perform the EKG during the IPPE visit, another physician or entity must perform and/or interpret the EKG. The performing provider bills the appropriate G code for the screening EKG and not a CPT code in the 93000 series. If the deductible has not been met, the usual coinsurance provisions would apply.
Questions should be directed to Neil Walsh at 617-732-9377 or cwalsh6@partners.org